The role of oral (methyl)ergometrine in the prevention of postpartum haemorrhage

Postpartum haemorrhage (PPH) is one of the most important causes of maternal mortality in developing countries. A consensus was reached on active management of the third stage of labour for all parturients especially for those for whom the access to hospital services is difficult or time-consuming. Oral (methyl)ergometrine was considered to be a possible alternative prophylactic oxytocic, that was easy to administer and suitable to be used in developing countries. A research project was set up to investigate its suitability to be used for active management of the third stage of labour. It was examined on its stability under tropical conditions; on its pharmacokinetic and pharmacodynamic properties and on its clinical effect on the amount of bloodless after childbirth. Oral (methyl)ergometrine is unstable even when stored after refrigerated conditions. Its pharmacokinetic and dynamic properties are unpredictable and no clinical effect on reduction of bloodless after childbirth has been shown. To ameliorate a product's stability seems unlogical, if the same product shows unfavourable pharmacokinetics. All the more so, since the tablets do not show the wanted clinical effects. Oral (methyl)ergometrine is not an alternative to parenteral prophylactic oxytocic drugs in the active management of the third stage of labour.